Provider Demographics
NPI:1629249081
Name:HALLER, HEIDI S (APRN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:S
Last Name:HALLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ABRAHMS BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1508
Mailing Address - Country:US
Mailing Address - Phone:860-523-3854
Mailing Address - Fax:860-523-3828
Practice Address - Street 1:1 ABRAHMS BLVD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1508
Practice Address - Country:US
Practice Address - Phone:860-523-3854
Practice Address - Fax:860-523-3828
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003741363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500002281Medicare PIN
CTD400000238Medicare PIN